'Post-Abortion Syndrome' Based on Poor Science

Action Points

Explain to interested patients that a review of the literature showed that high-quality studies on the relationship between abortion and mental health outcomes found no significant differences between study and control groups.

In a review of the literature, high-quality studies showed no significant differences in long-term mental health between women who'd had an abortion and controls, Robert Blum, M.D., Ph.D., of Johns Hopkins, and colleagues reported in the December issue of Contraception.

"The best research does not support the existence of a 'post-abortion syndrome' similar to post-traumatic stress disorder," Dr. Blum said.

The abortion debate has been fueled by assertions that women who have the procedure suffer long-term psychological distress, the researchers said, and even the U.S. Supreme Court has cited adverse mental health outcomes for women as part of the rationale for limiting late-term abortions, the researchers said.

So to assess the quality and findings of recent research, the investigators reviewed 21 studies evaluating the relationship between abortion and mental health outcomes conducted between Jan. 1, 1989 and Aug. 1, 2008.

They chose the 1989 date as a starting point because then-president Ronald Reagan had asked U.S. Surgeon General C. Everett Koop for a comprehensive report on abortion in 1988.

At that time, Koop concluded that the politics of abortion were skewing scientific understanding of its impact, and added that the empirical evidence linking abortion to mental health problems was inconclusive and subject to investigator bias.

Studies chosen for the current review had to include at least 100 participants, have a follow-up period longer than 90 days after termination of pregnancy, and use a control group.

Final selected studies had sample sizes ranging from 120 to 133,950 women, a maximum follow-up time of 25 years, and participants from seven countries who ranged in age from 12 to 54.

The reviewers considered five criteria when rating each article on a scale from "excellent" to "very poor." The criteria included:

Use of an appropriate comparison group

Use of valid mental health measures

Control for pre-existing mental health status

Control for potentially confusing factors

Whether the research question was explored comprehensively

Findings of each study were also labeled as "neutral," "mixed," or "negative," and the researchers looked for patterns between study quality and the direction of the findings.

None of the studies received a rating of "excellent," although four "very good" studies had neutral findings, meaning there were no significant differences between the study group and the comparison group.

Among the "fair" studies. three had neutral findings and two others had negative findings, which indicated the abortion group fared worse than the control group.

Another three "fair" studies had mixed findings, with results that included both types of finding characterizations.

Studies with the most flawed methodology consistently found negative mental health consequences resulting from abortion. Four "poor" studies had mixed findings, three had negative findings, and one "very poor" study had negative findings.

Only one "poor" study had neutral findings.

"A clear trend emerges â€¦ [that] the highest quality studies had findings that were mostly neutral, suggesting few if any differences between aborters and their respective comparison groups in terms of mental health sequelae," the researchers said.

"If the relationship between long-term mental health and abortion is worth pursuing further, a higher standard of science than what characterizes most of the research today needs to be applied," they added.

"Research that fails to address the methodological shortcomings will add little to what is already known," they said.

But on the basis of their current findings, the researchers said that the weight of the highest-quality evidence refutes the notion that abortion is causally linked to mental health problems for most women.

They concluded that "making policy recommendations such as the enforcement of so-called "informed consent" laws (which often provide misinformation regarding mental health risks of abortion) is unwarranted based on the current state of the evidence."

"If the goal is to help women," they wrote, "we are obligated to base program and policy recommendations on the best science, rather than using science to advance political agenda."

The study was supported in part by the Frary Family Fund.

The authors made no declarations of conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.